day 2

Question 1

what cells are round the outside of colloid

Answer 1

follicular

Question 2

what levels can discriminate between hyper, hypo and euthydroidism

Answer 2

TSH levels

Question 3

exceptions of when low TSH and low/normal T3 and T4

Answer 3

hypopituitarism

Question 4

tests for hyperthyroidism

Answer 4

TSH plus free T4 or T3

Question 5

tests for hypothyroidism

Answer 5

TSH plus serum free T4

Question 6

what levels are greatly increased in pregnancy

Answer 6

TBG and total T4 but free T4 is normal.

Question 7

what does amiodarone do

Answer 7

decrease t4 to t3 conversion and so t4 level may be higher than expected

Question 8

what antibodies are specific for graves

Answer 8

TSH receptor IgG antibodies

Question 9

what is the most common hypothyroidism

Answer 9

atrophic

Question 10

what autoimmune thyroiditis leads to goitre formation

Answer 10

Hashimotos thyroiditis

Question 11

what may cause hyperthyroidism, hypothyroidism or the 2 sequentially

Answer 11

post partum thyroiditis

Question 12

post partum thyroididits has a high chance of proceeding to permanent

Answer 12

hypothyroidism

Question 13

what is the mechanism of goitre

Answer 13

borderline hypothyroidism leading to TSH stimulation and thyroid enlargement in the face of continuing iodine deficiency

Question 14

specific signs of hypothyroidism

Answer 14

dry thin hair, bradycardia, dry skin, slow relaxing reflexes

Question 15

slow, dry haired, thick skinned, deep voiced, weight gain, cold intolerance, bradycardia and constipation is a classic picture of

Answer 15

hypothyroidism

Question 16

what confirms primary hypothyroidism

Answer 16

high TSH levels with low T4

Question 17

why should complete suppression of TSH be avoided

Answer 17

risk of atrial fib and osteoporosis

Question 18

pregnant woman should have optimal replacement as mothers with elevated TSH during pregnancy can result in kids with

Answer 18

reduction in cognitive function

Question 19

severe hypothyroidism may present with

Answer 19

confusion or even coma

Question 20

what mental health illness is common in hypothyroidism

Answer 20

depression

Question 21

nearly all cases of hyperthyroidism are caused by

Answer 21

intrinsic thyroid disease

Question 22

most common cause of hyperthyroidism

Answer 22

graves disease

Question 23

what condition produces antibodies that pretend to be TSH

Answer 23

graves

Question 24

signs of thyrotoxicosis, diffuse goitre and extra thyroidal manifestations eg opthalmopathy

Answer 24

graves

Question 25

signs of thyrotoxicosis, palpable solitary nodule or multinodualr goitre

Answer 25

solitary multinodular thyrotoxicosis

Question 26

signs of thyrotoxicosis, diffuse goitre and tender on palpation

Answer 26

thyroiditis

Question 27

specific signs of hyperthyroidism

Answer 27

tremor, hyperkinesis (excessive restlessness), tachycardia or atrial fibrillation, full pulse, warm vasodilator peripheries, exophthalmus( bulging eyes), lid lag and stare (upper eyelid retraction), goitre bruit

Question 28

what is transient hyperthyroidism from an acute inflammatory process, probably viral in orgin

Answer 28

de quervains thyroiditis

Question 29

what may flow after de quervains thyroiditis after a few weeks

Answer 29

hypothyroidism

Question 29

what may flow after de quervains thyroiditis after a few weeks

Answer 29

hypothyroidism

Question 30

treatment of de quervains thyroiditis

Answer 30

acute phase - aspirin short term in severely symptomatic - prendisolone

Question 31

what drug has high iodine content

Answer 31

amiodarone

Question 32

some cancer drugs eg ipilimumab can cause

Answer 32

thyroiditis

Question 33

what is infiltration. of the skin on the shin

Answer 33

pretibial myxoedema

Question 34

frequently present with atrial fib is common in elderly in

Answer 34

hyperthyroidism/ graves - not sure which one

Question 35

children with excessive height, weight gain and hyperactivity have

Answer 35

hyperthyroidism

Question 36

very useful clinical symptom of hyperthyroidism

Answer 36

weight loss despite normal appetite

Question 37

signs that differentiate hyperthyroidism from anxiety

Answer 37

eye signs, diffuse goitre, proximal myopathy and wasting

Question 38

what confirms the diagnosis fo hyperthyroidism

Answer 38

serum TSH is suppressed and raised free T3 or T4

Question 39

antibodies seen in graves

Answer 39

TSH receptor stimulating antibodies and thyroid peroxidase antibodies (TPO) Tsh is 97-99% specific for graves TPO are present in80% of graves but are also found in normal individuals

Question 40

most used anti thyroid drug in UK

Answer 40

carbimazole

Question 41

what is another option that is also an antithyroid drug

Answer 41

propylthiouracil

Question 42

how long does it take for anti thyroid drugs. to work

Answer 42

10-20 days

Question 43

what drug can provide symptomatic control in hyperthyroidism

Answer 43

beta blockers eg propanolol

Question 44

what % of patients relapse after a course of carbimazole or propylthiouracil within the following 2 years

Answer 44

50

Question 45

side effects of carbimazole

Answer 45

angranuclocytosis may develop sore throat or unexplained fever and should have white blood cell counted

Question 46

when is radioactive iodine contraindicated

Answer 46

pregnancy and while breast feeding

Question 47

patients should not be on antithyroid drugs when on

Answer 47

radio iodine

Question 48

is there increased risk of malignancy after radioactive iodine

Answer 48

no

Question 49

some drugs given in thyroid storm

Answer 49

propranolol immediately, potassium iodide, antithyroid drugs, corticosteroids

Question 50

what is the preferred antithyroid drug at conception and during first trimester

Answer 50

propythiouracil

Question 51

why is propythiouracil given during conception and first trimester in hyperthyroidism

Answer 51

due to rare reports of congenital abnormalities

Question 52

why is carbimazole recommended during 2 and 3 trimester

Answer 52

as liver problems more frequently described on PTU

Question 53

high levels of HCG found in pregnancy causes what to TSH receptor and t3 and t4

Answer 53

suppressed TSH with slightly elevated T3/4

Question 54

if a mother has ever had graves she may still have circulating thyroid stimulating immunoglobulin and so

Answer 54

may stimulate metal thyroid and so foetus can become hyperthyroid

Question 55

what do you measure in foetus for thyroid status

Answer 55

foetal heart rate

Question 56

thyroid hormone resistance is an -- condition

Answer 56

inherited

Question 57

what is mutated and abnormal in thyroid hormone resistance

Answer 57

thyroid hormone receptor

Question 58

thryroid hormone resistance is diagnosed on basis of

Answer 58

raised t3/4 and normal TSH

Question 59

long term risk of hyperthyroidism may cause

Answer 59

osteoporosis and atrial fib which may predispose to thromboembolic disease

Question 60

graves orbitopathy can cause swelling and oedema of the muscles around the eye leading to

Answer 60

limitation of movement and proptosis

Question 61

proptosis and lid retraction in graves may limit the ability to

Answer 61

close eyes completely

Question 62

is goitre physiological or pathological

Answer 62

can be either

Question 63

excessive doses of what will induce goitre

Answer 63

carbimazole or PTU

Question 64

what Amy produce a diffuse increase in size of the thyroid

Answer 64

puberty and pregnancy

Question 65

goitre which is smooth and soft and may be associated with thyroid growth stimulating antibodies

Answer 65

simple goitre

Question 66

what 2 diseases are associated with firm diffuse goitre of variable size

Answer 66

Hashimoto's thyroididits and graves disease thyrotoxicosis

Question 67

when is a bruit in a goitre often present

Answer 67

thyrotoxicosis